TransMed
There’s Research Going on Everywhere—How much is Helpful to Us?
By Sheila Kirk, M.D.
Well, dear Reader, there is research taking place in and about the Transgender community but in comparison to research reported to benefit society in general—it is truly a "drop in the bucket."
Three recently reported studies have caught my attention, however. They are oriented to the non-Transgendered population but possibly this kind of scientific work could have some value to us and be applicable to some of the goals and health factors we face.
The first of these has to do with a process known as tissue engineering. This is an interdisciplinary field that applies the principles of engineering and the life sciences toward the development of biological substitutes that restore, maintain or improve tissue function. There are three basic approaches to this creation of new tissue in the human body:
- Isolated cells or cell substitutes—an approach—which avoids the rigors and the complications of surgery and allows for the replacement of only those cells that supply the needed function. Its potential limitations include failure of the infused cells to maintain their function and the all problematic possibility of immunlogical rejection.
- Tissue inducing substances, an approach that depends upon the purification and large-scale production of appropriate molecules for example growth factors and the availability of methods to deliver these molecules to their targets.
- Cell placed on or within matrices wherein cells are isolated from the body by special membranes which are so constructed to protect the transplant from the action of antibodies or immune cells. These systems are implanted in the body and the matrices are fashioned from natural materials such as collagen or synthetic polymers.
All of this is complex and boggles the mind but investigators have attempted to engineer virtually every mammalian tissue regardless of its emryologic origin. Those tissues are: Ectodermal i.e. nervous system tissue, cornea and skin. Endodermal i.e. liver, pancreas and tubular structures such as esophagus, trachea, intestine and portions of the urinary tract. And lastly Mesodermal structures such as cartilage, bone and muscle. This can extend to the heart muscle, blood vessels and even bone marrow where blood cells are made.
The potential for this area of research and for medical care in the future is overpowering. Can one dare to think that these techniques could be originated and developed to form organs in individuals who are not genetically programmed to have those organs? For example, could one believe a uterus with ovaries and fallopian tubes could be a possibility in a post-operative MTF some time in the future. That’s really heavy duty, isn’t it? To grow a uterus and tubes and ovaries will allow internal hormone production therefore none would be needed by prescription and –think of it—one would have periods and could have potential for child-bearing. Is this Science Fiction? Not Really! The existence of bacteria and antibiotics to combat them must have been overwhelming concepts to medical science a century ago. Why can't the potential of pregnancy in a post-operative MTF individual become a reality? That potential has been realized in other forms of life in this world i.e. the Seahorse.
There is a company in Cambridge, Mass. that is doing basic research in tissue engineering. In their production pipeline it is mentioned the application of these concepts to breast and nipple reconstruction in post-mastectomy genetic women with malignant disease. This is another area for thought. The development of breasts in genetic males wanting to feminize. As this method of breast construction in genetic females develops can it be applicable to Transgendered males? Our abilities to accomplish are limited only by the confines of our imagination it would seem!
In another area of research let’s look at the value of estrogen in genetic women with its effects on cognitive function and dementia (marked loss of intellectual function.) In previous articles, I’ve told of the medical reports that estrogen seems to be of help in the older genetic female population improving mental activity and in altering potential for or actual presence of Alzheimer’s Disease. I’ve pointed out that if estrogen therapy worked for genetic women in their post-menopausal years, could we believe that it could work for genetic males either pre- or post-operative?
No one knows really if any of this is so, certainly as we know about estrogen ‘s value in post-menopausal genetic females. As you know, it is confirmed and accepted that estrogen does protect them from osteoporosis and from heart disease. We suspect but haven’t yet proved its value in the same way for genetic males using this therapy and the very same has to be said regarding Alzheimer’s and estrogen. We don’t know as yet.
In the March 4th 1998 edition of the Journal of the American Medical Association (JAMA),,,there is a report that analyzes ten other studies of post-menopausal estrogen use and risk of dementia. The discussion is a long one but in summary they conclude the following: "There are plausible biological mechanisms by which estrogen might lead to improved cognition, reduced risk for dementia or improvement in the severity of dementia. Studies conducted in women, however, have substantial methodologic problems and have produced conflicting results. Large placebo controlled trials are required to address estrogen’s role in prevention and treatment of Alzheimer’s Disease and other dementias. Given the known risks of estrogen therapy, the authors continue "estrogen is not recommended for the prevention or treatment of Alzheimer’s Disease or other dementias until adequate trials have been completed."
This report and its conclusion should not be taken with discouragement or despair. They say very clearly that not enough creditable research has been done. Hence, this medication cannot be fully endorsed for these conditions at this time.
Will that research be done? Count on it! In groups of older age genetic women, decreased cerebral function and cognition occurs as frequently as heart disease and more frequently than stroke. Roughly 10% of all persons over 65 years of age have Alzheimer’s Disease. It affects 3.75 million people in the United States alone and costs 65 billion dollars annually in treatment and care. There is very little in the way of effective treatment or prevention strategies to combat this disorder. Research must be done with the every-increasing age of our population. Answers will be forthcoming and most probably genetic males on estrogen will be found to have similar protection, as do genetic females.
The last study that prompts my reporting to you is one that has to do with alcohol use and the incidence of breast cancer in genetic females. The incidence of breast cancer in genetic females is considerable greater than in genetic males and very importantly it seem that breast cancer in genetic males taking male estrogen is no greater than genetic males not taking it. The reported cases of breast cancer in Transsexuals pre and post-op are quite limited—perhaps only about 10 in the world’s medical literature. I have written before this, that the risks therefore, are very small indeed for our sisters using an estrogen program. Although I believe, that self-breast exams and periodic mammography are necessary. But I hasten to emphasize that we have no studies as yet to support my views and until we do, we must be cautious. Several things are important to mention. Those few in the community who are diagnosed with Kleinfelter’s Syndrome (a chromosomal abnormality—47XXY) are at definite risk even without estrogen use. Placing them on estrogen can potentiate the already great risk. Also, we don’t know what increased risks may exist for a estrogen using genetic male who has a predisposing gene factor in their family i.e. a mother, grandmother, maternal aunt or female sibling who has breast cancer.
There are other risk factors identified in the genetic female for development of breast malignancy. Hyperestrogen states of different kinds, obesity, pregnancy and breast feeding experience and aforementioned alcohol use. The last factor deserves some comment because we don’t know if some of the estrogen using and alcohol using genetic males in our community might share the risk with genetic female even if to a lesser degree. For a wide variety of reasons, alcohol abuse is a "bad scene." The personal, marital and social factors that are a part of alcohol misuse and are apt to be rendered unstable and irretrievable are legion. Some things that affect our physical and mental health are not controllable. We have no influence over many things that insult our well-being. But alcohol use is controllable. What we put into our blood stream with eating and drinking is very amenable to balance and selection. If it should be, that for an appreciable number in our community both alcohol and estrogen can combine to increase our risk for breast malignancy as it does in genetic females then shouldn’t we be paying attention? I think so! I hope you do as well.
Copyright 1998 Sheila Kirk, M.D.
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